MEDICARE: WINIFRED LILLY-TAYLOR, PHD, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	432	MN
2	103T00000X	Psychologist	1968	MN

General Provider Information

NPI Number	:	1861549016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINIFRED LILLY-TAYLOR, PHD, LP

Provider Business Mailing Address
First Line	:	2415 CROMWELL DR
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2523
Country	:	US
Telephone Number	:	612-929-2421
Fax Number	:

Provider Business Practice Location Address
First Line	:	2415 CROMWELL DR
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55410-2523
Country	:	US
Telephone Number	:	612-929-2421
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. WINIFRED LILLY-TAYLOR
Credential	:	PHD, LP
Telephone Number	:	612-929-2421

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	09/11/2025

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